Advances in radiation oncology for metastatic bone disease.
Thariat J, Fric D, Kerr C, Leysalle A, Angellier G, Dejean C, Tuillier T, Bensadoun RJ, Lagrange JL.
Bull Cancer. 2013 Oct 30.
Source
Centre Antoine-Lacassagne - Institut universitaire de la face et du cou, université Nice-Sophia-Antipolis, department of radiation oncology, 33, avenue Valombrose, 06300 Nice Cedex 2, France.Abstract
Irradiation of bone metastases primarily aims at alleviating pain,
preventing fracture in the short term. The higher doses and more
conformal dose distribution achievable while saving healthy tissue with
new irradiation techniques have induced a paradigm shift in the
management of bone metastases in a growing number of clinical
situations. A search of the English and French literature was conducted
using the keywords: bone metastases, radiotherapy, interventional
radiology, vertebroplasty, radiofrequency, chemoembolization.
Stereotactic irradiation yields pain
relief rates greater than 90% in Phase I/II and retrospective studies.
IMRT (static, rotational, helical) and stereotactic irradiation yield
local control rates of 75-90% at 2 years. Some situations previously
evaluated as palliative
are currently treated more aggressively with optimized radiation
sometimes combined modality interventional radiology. A recommendation
can only be made for stereotactic irradiation in vertebral
oligometastases or reirradiation. In the absence of a sufficient level
of evidence, the increasing use of conformal irradiation techniques can
only reflect the daily practice and the patient benefit while
integrating economic logic care.
The impact of these aggressive approaches on survival remains to be
formally demonstrated by interventional prospective studies or
observatories including quality of life items and minimal 2-year
follow-up.
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